鼻腔鼻窦动脉瘤样骨囊肿1例附文献复习

目的探讨鼻腔鼻窦动脉瘤样骨囊肿(aneurysmal bone cyst ABC)的发病机制、病理、临床表现、诊断及治疗。方法报道1例鼻腔鼻窦动脉瘤样骨囊肿的临床资料并复习相关文献。结果鼻腔鼻窦动脉瘤样骨囊肿在鼻内镜下完整切除。结论发生于鼻腔鼻窦的动脉瘤样骨囊肿非常少见,CT和MRI是作为诊断的主要依据,一般可在鼻内镜下切除。     

Aneurysmal bone cyst in the sphenoid bone: treatment with minimally invasive surgery

Aneurysmal bone cysts are vascular lesions that destroy and expand bone. We report a recently treated case of an aneurysmal cyst of the sphenoid bone. A 14-year-old girl presented with frontal headaches, bouts of nausea, and vomiting. Computed tomography and magnetic resonance imaging showed typical features of an aneurysmal bone cyst. Arterial embolization was undertaken before surgery. The endoscopic transnasal procedure used allowed the complete removal of the aneurysmal bone cyst. This use of minimally invasive surgery makes this case of interest to surgeons of the skull base and sinuses.     

Phinocerebral mucormycosis--report of a case

Rhinocerebral mucormycosis is a rare and fatal deep fungus infection occurring in debilitated patients. Its reports have been recently increased because of the increase of such conditions as uncontrolled diabetics, leukemia, and cancer. A 60-year-old male suffering from continuous headache and fever was diagnosed as meningitis, and repeated culture of cerebrospinal fluid was negative. Antibiotic therapy was ineffective. CT scan revealed brain abscess in the right frontal lobe and bone defect over the right posterior ethmoidal sinuses. Both maxillary and ethmoidal sinuses were operated on 38 years ago. The patient was suspected to have rhinologic brain abscess. We intended to remove the source of infection in the right posterior ethmoidal sinuses beneath the base of the skull and to repair the defect of dura mater. The operation was tried on the 6th hospital day. There was a cyst in the posterior ethmoidal sinuses and an intact denuded dura mater over the cyst. The causative organism was not detected by smear test, bacteriological and fungal culture. He relapsed into lethargy, and died on the 21st hospital day due to the vast cerebral infarction. Autopsy revealed rhinocerebral mucormycosis. The literature on this disease was also reviewed and discussed.     

Nasal dermoid cysts and sinuses

The authors discuss problems of the nasal dermoids treatment. They point at difficulties with settlement of right term of operation, and they stress that X-ray diagnosis before operation should be taken into consideration to exclude the contact of the dermal cyst or sinuses with cranial cavity. They confirm necessities of radical removal of the cyst or/and the sinus to gain the recovery. They analyse the material of 6 patients with dermal cysts or sinuses who were operated since 1988 to 1997 in the ENT Department of Municipal Hospital, Gdynia. They were 4 boys and 2 girls. In each case a cyst with fistulas was observed. All children were treated surgically, and their ages were 2-14 years (mean 6 1/2). In 2 cases there was self-existent destruction of the nasal bones, other 2 patients had median rhinotomy made, in 2 cases only simple excision of the cyst and sinuses was performed. In any case it was no recurrence of the disease (time of follow-up is 1-10 years). The analysis is illustrated with two case reports. The first case was a 2-year-old boy who had a dermal cyst with sinus penetrating into the cranial cavity. CT imaging did not reveal obvious evidences of that. During operation, a momentary CSF leak was observed but it was stopped using oxycel and tissucol. The second case, a 7-year-old boy, was treated by curettage of the dermoid, with recurrence after 6 months. This patient was cured after total resection of the cyst and sinuses. In conclusion, the authors present in detail signs that can attest that contact of the cyst with the cranial cavity exists. They stress the necessity of right surgical treatment in cases of dermal cysts of the nose to avoid recurrence or complications.     

Solid aneurysmal bone cyst of the mandible

Aneurysmal bone cyst is a rare, rapidly expanding, locally destructive, and often misdiagnosed lesion. It accounts for about 1-2% of primary biopsied bone tumours. About 60-70 cases have been reported in the jaws; particularly the molar regions. Eighty percent of patients are under 20 years of age. Aneurysmal bone cyst exists as a primary or secondary lesion. It may be conventional (95%) or solid (5%). The solid variant is more difficult to recognize. The practical importance of aneurysmal bone cyst lies in the fact that it must be differentiated from malignant tumours: mainly with giant cell tumours and teleangiectatic osteosarcoma.     

伴皮肤窦道的先天性外耳道狭窄及胆脂瘤的诊断与治疗

目的 探讨先天性外耳道狭窄合并胆脂瘤的临床特征,提高其诊治率.方法 回顾性分析2003年3月至2006年6月间收治的伴有窦道形成的先天性外耳道狭窄合并胆脂瘤患者的临床资料,共10例(10耳).结果 10耳均有耳后皮肤破溃流脓史,外耳道口直径约2 mm,颞骨CT显示10耳均有外耳道区域骨质吸收缺损,致骨性耳道增宽,增宽的外耳道内被软组织密度影填充.术中见10耳之外耳道内均充满胆脂瘤,且伴有耳道后上壁及下壁骨质压迫吸收.10耳均行外耳道成形术,其中8耳同时行听力重建术.术后病理报告均为胆脂瘤组织,未见腮裂囊肿及瘘管组织.10耳术后外耳道均通畅,行听力重建术的8耳,听力改善(听力级)20～35 dB.随访1～3年,未见胆脂瘤复发.结论 先天性外耳道狭窄伴发胆脂瘤者,其外耳道骨壁极易受累及,从而出现外耳道骨壁缺损及耳后或颈部窦道形成,颞骨CT检查可发现外耳道骨壁缺损及胆脂瘤密度影.     

The formation of sinus in congenital stenosis of external auditory canal with cholesteatoma

CONCLUSIONS: In congenital stenosis of the external auditory canal (CSEAC) with cholesteatoma, the bony wall of the external auditory canal (EAC) is most commonly involved. This involvement will lead to bone erosion of the EAC and may subsequently lead to the formation of postaural or cervical sinuses. High-resolution computed tomography (HRCT) of temporal bone can show characteristic signs of soft tissue mass in EAC, with adjacent bone erosion. OBJECTIVE: To investigate the clinical features, differential diagnosis and management of CSEAC with cholesteatoma. PATIENTS AND METHODS: The clinical information for 10 cases of CSEAC with cholesteatoma was retrospectively reviewed. RESULTS: The patients' ages ranged from 4.75 to 22 years (average 12 years). The diameter of EACs was < 2 mm. All 10 ears had a history of postaural fistulae or sinuses. Bone erosion of EAC was distinctly shown in HRCT of all cases, as well as soft tissue masses, which led to enlargement of the bony canals. All patients underwent canaloplasty; eight ears received hearing reconstructions at the same time. Cholesteatoma in EACs was confirmed during the operations, accompanied by compression and destruction of the post-superior and/or inferior bony wall. Postoperative pathologic examinations proved the diagnosis of cholesteatoma, and excluded any tissue of bronchial cleft cyst or fistula. After a follow-up of 1-3 years, no recurrent cholesteatoma was found in any of the 10 cases. All reconstructed EACs were clean and smooth. The hearing levels in the eight ears that received hearing reconstructions increased 20-35 dBHL.     

Cholesterol granuloma of the maxillary antrum

The cholesterol granuloma is a particular form of granulation tissue developing as part of a variety of tissue reactions, Cholesterol granuloma is not related to cholesteatoma which may be regarded as an epidermoid cyst of the middle ear or temporal bone. Cholesterol granulomas are rarely associated with such cases (Friedmann, 1976; Gherini et al., 1985). Microscopically, the cholesterol granuloma consists of dense masses of cholesterol crystals which appear as clefts. They are surrounded by foreign body giant cells, foam cells, plasma cells and lymphocytes. There is frequently some fresh blood and some blood pigment (Wilhelm, 1977; Beales, 1979; Gibb, 1979). It seems probable that inflammation and prolonged obstruction of a bony cavity that is normally aerated, are the main ways in which cholesterol is concentrated in the paranasal sinuses. It could be expected to be relatively frequent in the maxillary and frontal sinus, but only a few cases have been reported in the literature and only nine cases affecting the maxillary sinus have been published over the last 22 years (Milton and Bickerton, 1986). We have recently found a cholesterol granuloma arising in the maxillary antrum.     

鼻咽癌放疗后蝶窦病变

报道５例鼻咽癌放射治疗所引起的后遗症一蝶窦病变。其潜伏期长达８～１４年；临床主要表现为复视、头痛；视力下降发展到视神经萎缩。出现岩尖综合征１例，周围性面瘫１例。经二种途径三种术式治疗后，效果良好。病检报告为潴留囊肿２例，肉芽增生２例，骨坏死并坏死组织潴留１例。     

巨大筛额上颌窦黏液囊肿1例

患者,女,75岁,17年前“感冒”后出现右面颊部肿胀及疼痛,当地医院行鼻窦CT检查示鼻腔肿物,经抗感染及对症治疗;3年前出现右眼视力下降,渐至失明;1年前在当地行经口“抽脓”治疗,疼痛缓解;半年前开始上述症状再发并加重。我科于2013年10月以“鼻腔鼻窦占位”收住院。体检：右侧面颊部隆起,质硬;右眼突出,向外上移位,瞳孔散大,无光感;鼻中隔偏左,右侧鼻腔外侧壁内移,中鼻道及以上看不见;张口略受限,右侧硬腭稍隆起,软腭明显隆起。     

Aneurysmal bone cyst of the hyoid.

Aneurysmal bone cyst is a rare lesion usually of the long bones, well documented in the literature. It is a cystic, osteolytic vascular tumour, replete with giant cells and fibrous septa, yet devoid of endothelial lining. It has been reported in the larynx and maxillary sinus. This appears to be the first report of an aneurysmal bone cyst occurring in the hyoid bone.     

Aneurysmal bone cyst of maxilla with ectopic molar tooth – A case report

Aneurysmal cysts of bone are rare non-neoplastic, locally aggressive lesion of bone with propensity for rapid growth, affecting mainly the long bones and spine. It rarely occurs in the head and neck region and within the head and neck mandible (especially the molar areas) is common. Aneurysmal cyst of bone involving the maxilla in the first decade of life is even rarer. We report a case of giant aneurysmal bone cyst of maxilla in eight-year-old male with ectopic molar tooth within the cyst. Is endoscopic excision possible? Endoscopic excision of the cyst was done successfully and no recurrence was noted even after 1 year of follow up.     

Aneurysmatische Knochenzyste im Bereich der Orbita bei einem 2-jährigen Kind

An aneurysmal bone cyst is a rare tumor-like lesion which can affect any part of the skeleton. It is a disease of childhood and adolescence. Reports of its occurrence on the skull base in children are rare. A 22-month-old male patient was admitted to our ENT department with a sudden protrusion of the right eyeball. Radiologically, a cystic, well-defined and contrast enhanced mass on the medial-cranial orbital wall with beginning destruction of the frontal skull base was detected. Histological assessment of a biopsy, which was taken by medial orbitotomy, showed giant-cellular and fibrohistiocytic changes. Definitive histological diagnosis after removal showed an aneurysmal bone cyst. If there is evidence for aggressive, expansive growth, an aneurysmal bone cyst should be included into the ENT-differential diagnosis of orbital tumors. It is not possible to confirm diagnosis from clinical or radiological data. Early biopsy is essential for a reliable diagnosis even if histological assessment is challenging.     

鼻窦球囊导管扩张术联合纤维鼻咽喉镜治疗鼻窦囊肿

目的 评价鼻内镜鼻窦手术和鼻窦球囊导管扩张术联合纤维鼻咽喉镜治疗鼻窦囊肿的疗效。方法 分析14例(19个上颌窦,3个额窦)应用鼻窦球囊导管扩张术联合纤维鼻咽喉镜手术切除鼻窦囊肿(球囊组)和16例(23个上颌窦,8个额窦)采用常规鼻内镜鼻窦手术方式切除鼻窦囊肿(常规组)病例的临床资料。依视觉模拟量表(visual analogue scale, VAS)记录手术难度评分和手术时间。手术前后均行鼻内镜检查、冠状位鼻窦CT检查,采用Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分系统评价预后。结果 球囊组手术难度高于常规组,手术时间也较长,两组间差异有统计学意义（P<0.001）。术后观察8、24周, 鼻内镜检查见窦口通畅,Lund-Kennedy内镜和Lund-Mackay鼻窦CT评分结果显示,所有病例术腔恢复良好,术后鼻窦CT影像示改善明显,但两组比较差异无统计学意义（P>0.05）。结论 球囊组与常规组行鼻窦囊肿手术可获得同-良好的疗效。球囊组的手术方式能够保留鼻腔鼻窦的正常结构,手术微创。由于纤维鼻咽喉镜手术器械的限制,手术难度较常规组高,手术时间较长。     

Cholesterol granuloma in thyroglossal cysts: a clinicopathological study

Thyroglossal duct cyst (TDC) is a congenital anomaly caused by retention of epithelial remnants from the descent of the thyroid gland during embryological development. Cholesterol granuloma represents a granulomatous reaction to precipitates of cholesterol crystals in tissue, usually related to middle-ear disease. The association of TDC with cholesterol granuloma has hardly been reported. This study describes five patients with TDC and cholesterol granuloma over a 16-year-period. The treatment consisted of excision of the TDC and the mid-portion of the hyoid bone and excision of a core of tissue between the hyoid bone and the foramen cecum (Sistrunk procedure). We speculate that the pathogenesis of cholesterol granuloma in TDC resembles that in the paranasal sinuses, as both sites provide a closed, poorly ventilated hollow structure with slow drainage. Our five patients accounted for 13% of all patients with TDC treated in our center during the same period, indicating that cholesterol granuloma in TDC may not be as rare as previously thought.     

Epidermoids of the paranasal sinuses and beyond: endoscopic management

BACKGROUND: Epidermoid tumors of the craniofacial skeleton are uncommon, with the exception of acquired cholesteatoma of the temporal bone. These lesions may be primary embryologic in origin or, less frequently, may be iatrogenic or posttraumatic. METHODS: We report three cases of unusually encountered epidermoids, all of which were managed by endoscopic marsupialization via paranasal sinus approaches. We also review the pathophysiology and clinical presentation of these rare entities. RESULTS: The first patient is a 60-year-old man with a congenital epidermoid of the petrous apex removed via an endoscopic transsphenoid approach assisted by image-guided surgical navigation with CT/MRA merge. The second case is a 48-year-old woman with a history of trauma found to have a mass in the pterygopalatine space. An endoscopic transmaxillary approach was used to ligate the internal maxillary artery and marsupialize the cyst into the maxillary sinus. The third patient is a 22-year-old woman with a supraorbital ethmoid epidermoid tumor discovered intraoperatively during surgery for a presumed mucocele. This patient also had a known history of trauma. The cyst was marsupialized into the adjacent frontal sinus. Image-guided surgical navigation using CT was performed in the latter two cases. All patients are free of recurrence with follow-up ranging from 14 to 26 months. CONCLUSION: With advancements in endoscopic techniques, including the use of image guidance, many of these relatively uncommon lesions can be managed by minimally invasive approaches via the paranasal sinuses.     

Aneurysmal bone cyst of the zygoma. A case report and review of the literature

Aneurysmal bone cyst is a cystic vascular osseous tumor. It is rare in the craniofacial area; it is even rarer in the zygoma. A case of aneurysmal bone cyst of the zygoma was presented. Its pathogenesis, clinical and radiological features and treatment options were discussed under the view of the literature.     

Solitary plasmacytoma and extramedullary plasmacytoma of the paranasal sinuses and soft palate

Solitary plasmacytoma of the paranasal sinuses are uncommon neoplasms of B lymphocyte origin. They comprise one per cent of all head and neck tumours of the upper respiratory tract. They can be solitary plasmacytomas of the bone (SPB), an extramedullary plasmacytoma or a local manifestation of multiple myeloma. Conversion to multiple myeloma happens more frequently in SPB. Radiotherapy is the common modality of treatment with, or without, adjuvant chemotherapy. Extramedullary plasmacytoma carries a better prognosis than a solitary plasmacytoma of the bone. We report four cases of solitary plasmacytoma of the bone and an extramedullary plasmacytoma of the paranasal sinuses and soft palate.     

Mandibular aneurysmal bone cyst mimicking a malignant tumor

CASE: We report the case of a 24-year-old woman presenting with a rapidly growing mass in the right masseteric region. MRI suggested a diagnosis of a rhabdomyosarcoma but CT-scan evoked a benign lesion such as chondroblastoma or aneurismal bone cyst. The biopsy specimen proved the diagnosis of aneurismal bone cyst and the patient was treated by surgical curettage. There was no recurrence after 4 years of follow-up. DISCUSSION: The aneurismal bone cyst of the jaw is a rare pseudocystic lesion, characterized by replacement of the normal bone with fibro-osseous tissue containing blood-filled sinusoidal or cavernous spaces. The lesion generally affects young persons under 20 years of age. The molar region, the angle, and the ascending ramus of the mandible are the predominantly affected sites. The lesion does not have any clinical or radiological specificity and surgical curettage is the standard treatment. Recurrence is rare and occurs within 30 months after surgery.     

Cholesterol cysts of the temporal bone: diagnosis and treatment

Cholesterol cyst (or granuloma) of the temporal bone, a recognized clinical entity distinct from cholesteatoma, is more common than previously thought. Apparently it is caused by obstruction of previously pneumatized temporal bone air cells. Surgical cure is achieved by drainage and reestablishment of normal pneumatization. This paper reviews 14 cholesterol cysts of the temporal bone, emphasizing the importance of preoperative imaging and surgical approach. Use of magnetic resonance imaging differentiates cholesterol cysts from cholesteatoma or other neoplasms. Computed tomography delineates the location of the lesion and defines temporal bone anatomy essential to surgical approach. The two studies together allow the surgeon to properly plan drainage, as in the case of a cholesterol cyst, versus excision or exteriorization, as in the case of cholesteatoma. The infralabyrinthine approach to a petrous apex cholesterol cyst is the procedure of choice when hearing preservation is desired.